oligohydramnios 1 dr mona shroff

OLIGOHYDRAMNIOSOLIGOHYDRAMNIOS

11Dr Mona Shroff Dr Mona Shroff

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PHYSIOLOGY OF AMNIOTIC FLUIDPHYSIOLOGY OF AMNIOTIC FLUID

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INFLOWINFLOW (1000 ml/d)(1000 ml/d)

1.FETAL URINE1.FETAL URINE2.LUNG LIQUID2.LUNG LIQUID

INTRAMEMBRANOUS (placenta,cord)INTRAMEMBRANOUS (placenta,cord) TRANSMEMBRANOUS(amniotic membranes)TRANSMEMBRANOUS(amniotic membranes) RECYCLING – 3hrsRECYCLING – 3hrs

OUTFLOWOUTFLOW (1000 ml/d)(1000 ml/d)

1.FETAL 1.FETAL SWALLOWINGSWALLOWING



FUNCTIONS OF AMNIOTIC FLUIDFUNCTIONS OF AMNIOTIC FLUID Shock absorber – protects from external Shock absorber – protects from external

trauma.trauma. Protects cord from compression.Protects cord from compression. Permits fetal movements – development of Permits fetal movements – development of

musculoskeletal system, prevents adhesions.musculoskeletal system, prevents adhesions. Swallowing of AF enhances growth & Swallowing of AF enhances growth &

development of GIT.development of GIT. AF volume maintains AF pressure – reduces loss AF volume maintains AF pressure – reduces loss

of lung liquid – pulmonary development.of lung liquid – pulmonary development. Maintenance of fetal body temperature.Maintenance of fetal body temperature. Some fetal nutrition, water supply.Some fetal nutrition, water supply. Bacteriostatic properties – decreases potential Bacteriostatic properties – decreases potential

for infection for infection 44Dr Mona Shroff Dr Mona Shroff


55Dr Mona Shroff Dr Mona Shroff www.obgyntoday.infowww.obgyntoday.info

DEFINITIONDEFINITION

AMNIOTIC FLUID VOLUME < 5 th AMNIOTIC FLUID VOLUME < 5 th percentile for gestational agepercentile for gestational age

AMNIOTIC FLUID INDEX < 5AMNIOTIC FLUID INDEX < 5

SINGLE VERTICAL POCKET < 2 cmsSINGLE VERTICAL POCKET < 2 cms



INCIDENCEINCIDENCE

0.5 – 5%0.5 – 5%



AETIOLOGYAETIOLOGYFETALFETAL PROM (50%)PROM (50%) CHROMOSOMAL ANOMALIESCHROMOSOMAL ANOMALIES CONGENITAL ANOMALIESCONGENITAL ANOMALIES IUGRIUGR IUFDIUFD POSTTERM PREGNANCYPOSTTERM PREGNANCY

MATERNALMATERNAL PREECLAMPSIAPREECLAMPSIA APLA SYNDROMEAPLA SYNDROME CHRONIC HTCHRONIC HT

PLACENTALPLACENTAL CHRONIC ABRUPTIONCHRONIC ABRUPTION TTTSTTTS CVSCVS

DRUGSDRUGS PG SYNTHETASE INHIBITORSPG SYNTHETASE INHIBITORS ACE INHIBITORSACE INHIBITORS

IDIOPATHIIDIOPATHICC88Dr Mona Shroff Dr Mona Shroff


DIAGNOSISDIAGNOSIS SYMPTOMSSYMPTOMS

NO SPECIFIC NO SPECIFIC SYMPTOMSSYMPTOMS

H/O leaking p/vH/O leaking p/vPosttermPostterms/o preeclampsias/o preeclampsiaDrugsDrugsLess fetal movementsLess fetal movements

SIGNSSIGNS

Uterus – small for Uterus – small for datedate

Feels full of fetusFeels full of fetusMalpresentationsMalpresentationsIUGRIUGR



USGUSGMETHODSMETHODS MVP <2 cmsMVP <2 cms (<1 severe)(<1 severe)

AFI <5 cmsAFI <5 cms (5-8 borderline)(5-8 borderline)

2D pocket <15 sq 2D pocket <15 sq cmscms



COMPLICATIONSCOMPLICATIONS FETALFETALAbortionAbortionPrematurityPrematurityIUFDIUFDDeformities –Deformities –

CTEV,contractures,amputationCTEV,contractures,amputationPotters syndrome- pulmonary Potters syndrome- pulmonary

hypoplasiahypoplasiaMalpresentationsMalpresentationsFetal distressFetal distressMSAF – MASMSAF – MASLow APGARLow APGAR

MATERNALMATERNAL

Increased morbidityIncreased morbidity

Prolonged labour: Prolonged labour: uterine inertiauterine inertia

Increased operative Increased operative interventionintervention

(malformations,(malformations,distres)distres)



MANAGEMENTMANAGEMENTDEPENDS UPONDEPENDS UPON

AETIOLOGYAETIOLOGYGESTATIONAL AGEGESTATIONAL AGESEVERITYSEVERITYFETAL STATUS & WELL BEINGFETAL STATUS & WELL BEING



DETERMINE AETIOLOGYDETERMINE AETIOLOGY

R/O PROMR/O PROMTARGETED USG FOR ANOMALIESTARGETED USG FOR ANOMALIESR/O IUGR ,IUFD when suspectedR/O IUGR ,IUFD when suspectedAmniocentesis if chromosomal Amniocentesis if chromosomal

anomalies suspected – early anomalies suspected – early symmetric IUGRsymmetric IUGR

Tests for APLA Syndrome , if suspected Tests for APLA Syndrome , if suspected 1313Dr Mona Shroff Dr Mona Shroff


TREATMENTTREATMENT ADEQUATE REST – decreases dehydrationADEQUATE REST – decreases dehydration HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d)HYDRATION – Oral/IV Hypotonic fluids(2 Lit/d) temperory increasetemperory increase helpful during labour,prior helpful during labour,prior to ECV, USGto ECV, USG• SERIAL USG – Monitor growth,AFI,BPPSERIAL USG – Monitor growth,AFI,BPP• INDUCTION OF LABOUR/ LSCSINDUCTION OF LABOUR/ LSCS Lung maturity attainedLung maturity attained Lethal malformationLethal malformation Fetal jeopardyFetal jeopardy Sev IUGRSev IUGR Severe oligoSevere oligo



AMNIOINFUSIONAMNIOINFUSION

INDICATIONSINDICATIONS 1.Diagnostic1.Diagnostic 2.Prophylactic2.Prophylactic 3.Therapeutic3.Therapeutic Decreases cord Decreases cord

compressioncompression Dilutes meconiumDilutes meconium



TREATMENT ACC. TO CAUSETREATMENT ACC. TO CAUSEDrug induced – OMIT DRUGDrug induced – OMIT DRUGPROM – INDUCTIONPROM – INDUCTIONPPROM – Antibiotics,steroid – PPROM – Antibiotics,steroid –

InductionInductionFETAL SURGERYFETAL SURGERY VESICO AMNIOTIC SHUNT-PUVVESICO AMNIOTIC SHUNT-PUV Laser photocoagulation for TTTS Laser photocoagulation for TTTS



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oligohydramnios 1 dr mona shroff

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